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      The Impact of Visualization Format and Navigational Options on Laypeople’s Perception and Preference of Surgery Information Videos: Randomized Controlled Trial and Online Survey

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          Abstract

          Background

          Patients need to be educated about possible treatment choices in order to make informed medical decisions. As most patients are medical laypeople, they find it difficult to understand complex medical information sufficiently to feel confident about a decision. Multimedia interventions such as videos are increasingly used to supplement personal consultations with medical professionals. Former research has shown that such interventions may have a positive effect on understanding, decision making, and emotional reactions. However, it is thus far unclear how different features of videos influence these outcomes.

          Objective

          We aimed to examine the impact of visualization formats and basic navigational options in medical information videos about cruciate ligament surgery on recipients’ knowledge gain, emotions, attitude, and hypothetical decision-making ability.

          Methods

          In a between-group randomized experiment (Study 1), 151 participants watched 1 of 4 videos (schematic vs realistic visualization; available vs unavailable navigational options). In a separate online survey (Study 2), 110 participants indicated their preference for a video design. All participants were medical laypeople without personal experience with a cruciate ligament rupture and were presented with a fictional decision situation.

          Results

          In Study 1, participants who used navigational options (n=36) gained significantly more factual knowledge ( P=.005) and procedural knowledge ( P<.001) than participants who did not have or use navigational options (n=115). A realistic visualization induced more fear ( P=.001) and disgust ( P<.001) than a schematic video. Attitude toward the surgery ( P=.02) and certainty regarding the decision for or against surgery ( P<.001) were significantly more positive after watching the video than before watching the video. Participants who watched a schematic video rated the video significantly higher than that by participants who watched a realistic video ( P<.001). There were no significant group differences with regard to hypothetical decision making and attitude toward the intervention. In addition, we did not identify any influence of the visualization format on knowledge acquisition. In Study 2, 58 of 110 participants (52.7%) indicated that they would prefer a schematic visualization, 26 (23.6%) preferred a realistic visualization, 17 (15.5%) wanted either visualization, and 9 (8.2%) did not want to watch a video at all. Of the participants who wanted to watch a video, 91 (90.1%) preferred to have navigational options, 3 (3.0%) preferred not to have navigational options, and 7 (6.9%) did not mind the options.

          Conclusion

          Our study indicates that the perception of medical information videos is influenced by their design. Schematic videos with navigational options are the most helpful among all videos to avoid negative emotions and support knowledge acquisition when informing patients about an intervention. The visualization format and navigational options are important features that should be considered when designing medical videos for patient education.

          Trial Registration

          Deutsches Register Klinischer Studien DRKS00016003; https://www.drks.de/drks_web/ navigate.do?navigationId= trial.HTML&TRIAL_ID=DRKS00016003 (Archived by WebCite at http://www.webcitation.org/746ASSAhN)

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          Most cited references40

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          Informed decision making in outpatient practice: time to get back to basics.

          Many clinicians have called for an increased emphasis on the patient's role in clinical decision making. However, little is known about the extent to which physicians foster patient involvement in decision making, particularly in routine office practice. To characterize the nature and completeness of informed decision making in routine office visits of both primary care physicians and surgeons. Cross-sectional descriptive evaluation of audiotaped office visits during 1993. A total of 1057 encounters among 59 primary care physicians (general internists and family practitioners) and 65 general and orthopedic surgeons; 2 to 12 patients were recruited from each physician's community-based private office. Analysis of audiotaped patient-physician discussions for elements of informed decision making, using criteria that varied with the level of decision complexity: basic (eg, laboratory test), intermediate (eg, new medication), or complex (eg, procedure). Criteria for basic decisions included discussion of the nature of the decision and asking the patient to voice a preference; other categories had criteria that were progressively more stringent. The 1057 audiotaped encounters contained 3552 clinical decisions. Overall, 9.0% of decisions met our definition of completeness for informed decision making. Basic decisions were most often completely informed (17.2%), while no intermediate decisions were completely informed, and only 1 (0.5%) complex decision was completely informed. Among the elements of informed decision making, discussion of the nature of the intervention occurred most frequently (71 %) and assessment of patient understanding least frequently (1.5%). Informed decision making among this group of primary care physicians and surgeons was often incomplete. This deficit was present even when criteria for informed decision making were tailored to expect less extensive discussion for decisions of lower complexity. These findings signal the need for efforts to encourage informed decision making in clinical practice.
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            Option Grids: shared decision making made easier.

            To describe the exploratory use of short decision support tools for patients, called Option Grids. Option Grids are summary tables, using one side of paper to enable rapid comparisons of options, using questions that patients frequently ask (FAQs) and designed for face-to-face clinical encounters. To date, most evidence about 'patient decision aids' has been based on tools with high content levels, designed for patients to use independently, either before or after visits. We studied the use of Option Grids in a quality improvement project, collecting field notes and conducting interviews with clinical teams. In the 'Making Good Decisions in Collaboration' (MAGIC) program, clinicians found that using Option Grids made it easier to explain the existence of options and reported a 'handover' effect, where patient involvement in decision making was enhanced. Option Grids made options more visible and clinicians found it easier to undertake shared decision making when these tools were available. Used in a collaborative way, they enhance patients' confidence and voice, increasing their involvement in collaborative dialogs. Further work to confirm these preliminary findings is required, to measure processes and to assess whether these tools have similar impact in other clinical settings. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.
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              Informed Decision Making in Outpatient Practice

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                Author and article information

                Contributors
                Journal
                J Particip Med
                J Particip Med
                JoPM
                Journal of Participatory Medicine
                JMIR Publications (Toronto, Canada )
                2152-7202
                Oct-Dec 2018
                22 November 2018
                : 10
                : 4
                : e12338
                Affiliations
                [1 ] Knowledge Construction Lab Leibniz-Institut fuer Wissensmedien Tuebingen Germany
                [2 ] Institute of Clinical Anatomy and Cell Analysis Eberhard Karls University Tuebingen Tuebingen Germany
                [3 ] Department of Psychology Eberhard Karls University Tuebingen Tuebingen Germany
                Author notes
                Corresponding Author: Joachim Kimmerle j.kimmerle@ 123456iwm-tuebingen.de
                Author information
                http://orcid.org/0000-0001-9749-7321
                http://orcid.org/0000-0002-1312-4032
                http://orcid.org/0000-0002-7112-1016
                http://orcid.org/0000-0002-8996-8303
                http://orcid.org/0000-0002-6345-9498
                Article
                v10i4e12338
                10.2196/12338
                7434097
                64df2062-f911-432e-974d-7c4d1850406f
                ©Marie Eggeling, Martina Bientzle, Thomas Shiozawa, Ulrike Cress, Joachim Kimmerle. Originally published in Journal of Participatory Medicine (http://jopm.jmir.org), 22.11.2018.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in Journal of Participatory Medicine, is properly cited. The complete bibliographic information, a link to the original publication on http://jopm.jmir.org, as well as this copyright and license information must be included.

                History
                : 27 September 2018
                : 29 October 2018
                : 31 October 2018
                : 5 November 2018
                Categories
                Original Paper
                Original Paper

                attitude,decision aids,emotions,informed decision making,knowledge acquisition,medical decision making,surgery,video

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